International Journal of Scientific and Research Publications, Volume 4, Issue 11, November 2014 1 ISSN 2250-3153 www.ijsrp.org Hodgkins Lymphoma in Pregnancy: A Case Report Dr Neha Goyal, Dr Tushar Palve, Dr Aditi Parmar BCJ Hospital and Asha Parekh Research Centre Abstract- Pregnancy is a special phase in every woman’s life and demands special care because even a small mishap can turn this happy journey in to a scary nightmare. That’s why treating any ailment including malignancy merits special consideration as it can have a long lasting impact on two lives. Hodgkins lymphoma is one of the common malignancy encountered during pregnancy and chemotherapy plays a central role in its management. Chemotherapeutic drugs with their toxic effects can have a profound effect on the outcome of pregnancy. Keeping this view in mind we report our experience of treating such patient in a tertiary care hospital and try to highlight the challenges involved. Lymphoma is a rare diagnosis in pregnancy. Chemotherapy and radiotherapy during the first trimester is associated with fetal malformation risk which diminishes as pregnancy advances. In view of relative rarity of such cases there is a critical need for multicentre cooperation and a central registry to collect data on such cases and their follow up so that treating physicians could assess more accurately the safety of different chemotherapeutic agents in pregnancy. Index Terms- Hodgkins Lymphoma, Pregnancy, Chemotherapy I. INTRODUCTION odgkin lymphoma (Hodgkin’s disease, HL) accounts for only 10 percent of all lymphomas, but it is one of the most frequent malignancy diagnosed during pregnancy, occurring in approximately 1:6000 deliveries 1-3 and this accounts for 3 percent or fewer of all patients with HL. In coming years incidence of lymphomas in pregnancy may increase due to the current trend to postpone pregnancy until later in life and the probable association of AIDS-related non-Hodgkin’s lymphoma (NHL) in developing countries like India. 4-5 Thus proper diagnosis and management of HL becomes imperative. II. CASE REPORT A 28 yrs old primigravida with 6 months amenorrhea came with pain and swelling in lower extremities, joint pain, weight loss, chronic cough and generalized pain and weakness since. She had h/o pulmonary Koch’s 7 yrs back & took AKT for 6 months. Her general condition was poor, she was cachexic and pale. On respiratory examination there were decreased bronchial sounds on right side with occasional crepts. On investigating she had leucocytosis (WBC 33700 with neutrophilia), ESR-110, CRP-positive (45),HIV-negative, RFT &LFT-normal. Chest x- ray (figure 1)was s/o Rt lower lung mass with Rt. Sided pleural effusion with? Pulmonary Koch’s, 3 samples of sputum were negative for AFB but culture showed fluconazole resistant Candida species USG (OBS)- SLIUG 25 wks, Placenta- anterior grade 1, EFW-748 gms, IUGR baby. HRCT (figure 2) showed large lung mass with cavitation in right middle lobe of lung with 10*9*9.6 cms with extensive mediastinal & subcarinal adenopathy (fig1). Cylindrical broncheitasis in rt upper & lower lobes. CT guided biopsy of mediastinal mass was done. Biopsy (figure 3) was suggestive of classical Hodgkins Lymphoma (fig.2). On IHC cells were positive for CD30 & MUM-1 and negative for LCA, CD15, CD20, CD3. Oncology referral was done and she was diagnosed with case stage-2-3 hodgkins lymphoma. Chemotherapy was started (ABVD) along with antibiotics. Within 3 days pt. went in spontaneous preterm labour & delivered a preterm female baby of 930 grams vaginally .Her postnatal period was uneventful but unfortunately baby expired on day 8 post delivery. III. DISCUSSION In women 15–24 years of age, HL is the one of the most frequently encountered malignancy, accounting for 51% of the hematologic malignancies complicating pregnancy. 6 Single women have higher rates of the disease than married women, as do women with lower parity or late age at first full-term pregnancy. 7-8 Many studies suggest that HL presents with typical manifestations in the pregnant woman. 9-10. Pregnancy also does not seem to affect the stage of disease at presentation, the response to therapy, or the overall survival rate from HL. 6 To establish a diagnosis and classify the subtype of lymphoma, histopathological examination of a lymph node biopsy is mandatory which can be safely done under local or general anesthesia during pregnancy. 2,11 Nodular sclerosis is the commonest subtype encountered even in this subgroup. 2 The HASTE sequence of MRI provides a rapid and comprehensive imaging of the entire chest that has largely replaced conventional MRI, and provides enough information on lymph node size with no measurable radiation risk to the fetus. PET/CT should be performed after delivery to assess treatment response. Each patient must be looked at individually for treatment options because HL diagnosed in first trimester does not constitute an absolute indication for therapeutic abortion. 12 If the HL presents in early stage above the diaphragm patients can be followed carefully with induction at 32 – 36 weeks 13-15 and definite treatment can be offered afterwards. 16 Alternatively, these patients can receive radiation therapy with proper shielding. 17-20 In a study at M.D. Anderson authors reported no congenital abnormalities in 16 babies delivered after the mothers had received supradiaphragmatic radiation while shielding the uterus with five half-value layers of lead. 21 Because of theoretical risks that the fetus might develop future malignancies from even minimal scattered radiation doses outside the radiation field, H